Centre for Applied Health Research & Delivery (CAHRD), Liverpool School of Tropical Medicine, Liverpool, UK
Health insecurity has emerged as a major concern among health policy-makers particularly in low- and middle-income countries (LMICs). It includes the inability to secure adequate healthcare today and the risk of being unable to do so in the future as well as impoverishing healthcare expenditure. The increasing health insecurity among 150 million of the world’s poor has moved social protection in health (SPH) to the top of the agenda among health policy-makers globally. This paper aims to provide a debate on the potential of social protection contribution to addressing health insecurity, poverty, and vulnerability brought by healthcare expenditure in low-income countries, to explore the gaps in current and proposed social protection measures in healthcare and provide suggestions on how social protection intervention aimed at addressing health insecurity, poverty, and vulnerability may be effectively implemented.
Bonilla-Chacín ME, Aguilera N. The Mexican social protection system in health.Washington DC: The World Bank; 2013.
Jacobs B, Bigdeli M, Pelt MV, Ir P, Salze C, Criel B. Bridging community‐based health insurance and social protection for health care–a step in the direction of universal coverage? Trop Med Int Health. 2008;13(2):140-143. doi:10.1111/j.1365-3156.2007.01983.x
World Health statistics 2011. Geneva: World Health Organisation; 2011.
Wagstaff A. Social health insurance reexamined. World Bank Policy Research Working Paper No. 4111; 2007.
Knaul FM, Gonzalez-Pier D, Gomez-Dantes O, Garcia-Junco D, Arreola-Omelas H. The Quest for Universal Health Coverage: Achieving Social Protection for All in Mexico. Lancet. 2012;380(9849):1259-1279. doi:10.1016/S0140-6736(12)61068-X.
Ruger JP. An alternative framework for analyzing financial protection in health. PLoS Med. 2012;9(8):e1001294. doi:10.1371/journal.pmed.1001294
Jamison DT, Summers LH, Alleyne G, et al. Global health 2035: a world converging within a generation. Lancet. 2013;382(9908):1898-1955. doi:10.1016/s0140-6736(13)62105-4
Abu-Zaineh M, Romdhane HB, Ventelou B, Moatti JP, Chokri A. Appraising financial protection in health: the case of Tunisia. Int J Health Care Finance Econ. 2013;13(1):73-93. doi:10.1007/s10754-013-9123-8
Tangcharoensathien V, Mills A, Palu T. Accelerating health equity: the key role of universal health coverage in the Sustainable Development Goals. BMC Med. 2015;13: 101. doi:10.1186/s12916-015-0342-3
Schmidt H, Gostin LO, Emanuel E. Public health, universal health coverage, and Sustainable Development Goals: can they coexist? Lancet. 2015. doi:10.1016/s0140-6736(15)60244-6
Lund C. Poverty, inequality and mental health in low-and middle-income countries: time to expand the research and policy agendas. Epidemiol Psychiatr Sci. 2015;24(2):97-99. doi:10.1017/S2045796015000050
De Freitas C, Martin G. Inclusive public participation in health: Policy, practice and theoretical contributions to promote the involvement of marginalised groups in healthcare. Soc Sci Med. 2015;135: 31-39. doi:10.1016/j.socscimed.2015.04.019
Wagstaff A. Health equity and financial protection: streamlined analysis with ADePT software. World Bank Publications; 2011.
Buigut S, Ettarh R, Amendah DD. Catastrophic health expenditure and its determinants in Kenya slum communities. Int J Equity Health. 2015;14:46. doi:10.1186/s12939-015-0168-9
Ilunga-Ilunga F, Levêque A, Laokri S, Dramaix, M. Incidence of catastrophic health expenditures for households: An example of medical attention for the treatment of severe childhood malaria in Kinshasa reference hospitals, Democratic Republic of Congo. J Infect Public Health. 2015;8(2):136-144. doi:10.1016/j.jiph.2014.08.008
Foster N, Vassall A, Cleary S, Cunnama L, Churchyard G, Sinanovic E. The economic burden of TB diagnosis and treatment in South Africa. Soc Sci Med. 2015;130:42-50. doi:10.1016/j.socscimed.2015.01.046
Davies SC, Winpenny E, Ball S, Fowler T, Rubin J, Ellen Nolte E. For debate: a new wave in public health improvement. Lancet. 2014;84(9957):1889-1895.doi:10.1016/s0140-6736(13)62341-7
Hanlon P, Carlisle S, Hannah M, Reilly D Lyon A. Making the case for a ‘fifth wave’ in public Health. Public Health. 2011;124(1):30-36. doi:10.1016/j.puhe.2010.09.004
Merrien FX. Social Protection as Development Policy: A New International Agenda for Action. International Development Policy. 2015. http://poldev.revues.org/1525
Leive A, Xu K. Coping with out-of-pocket health payments: empirical evidence from 15 African countries. Bull World Health Organ. 2008;86(11):849-856. doi:10.2471/blt.07.049403
O'Donnell OA, Wagstaff A. Analyzing health equity using household survey data: a guide to techniques and their implementation. World Bank Publications; 2008. doi:10.1596/978-0-8213-6933-3
Deller B, Tripathi V, Stender S, Otolorin E, Johnson P, Carr C. Task shifting in maternal and newborn health care: Key components from policy to implementation. Int J Gynaecol Obstet. 2015;130:S25-S31. doi:10.1016/j.ijgo.2015.03.005
Ensor T, Cooper S. Overcoming barriers to health service access: influencing the demand side. Health Policy Plan. 2004;19(2):69-79. doi:10.1093/heapol/czh009
Ellis RP, McGuire TG. Supply-side and demand-side cost sharing in health care. J Econ Perspect. 1993;7(4):135-151. doi:10.1257/jep.7.4.135
Gopalan SS, Mutasa R, Friedman J, Das A. Health sector demand-side financial incentives in low-and middle-income countries: A systematic review on demand-and supply-side effects. Soc Sci Med. 2014;100:72-83. doi:10.1016/j.socscimed.2013.10.030
Kankeu HT, Boyer S, Fodjo Toukam R, Abu‐Zaineh M. How do supply‐side factors influence informal payments for healthcare? The case of HIV patients in Cameroon. Int J Health Plann Manage. 2014. doi:10.1002/hpm.2266.
Mehra D, de Pee S, Bloem MW. (2015). Nutrition, Food Security, Social Protection, and Health Systems Strengthening for Ending AIDS. In: Ivers L, eds. Food Insecurity and Public Health. CRC Press; 2015.
World Health Organization (WHO). The impact of universal insurance program on catastrophic health expenditure: simulation analysis for Kenya. Geneva: WHO; 2006.
Chuma J, Maina T. Catastrophic health care spending and impoverishment in Kenya. BMC Health Serv Res. 2012;12(1):413. doi:10.1186/1472-6963-12-413
Barros AJ, Bastos JL, Dâmaso AH. Catastrophic spending on health care in Brazil: private health insurance does not seem to be the solution. Cadernos de Saúde Pública. 2011;27: s254-s262. doi:10.1590/S0102-311X2011001400012
Camacho A, Conover E. (2011). Manipulation of social program eligibility. Am Econ J Econ Policy. 2011;3(2):41-65. doi:10.1257/pol.3.2.41
Gama ES. The implications of contracting out health care provision to private not-for-profit health care providers: the case of service level agreements in Malawi [Doctoral dissertation]. Musselburgh: Queen Margaret University; 2013.
Miller G, Pinto DM, Vera-Hernández M. Risk protection, service use, and health outcomes under Colombia's health insurance program for the Poor (No. w15456). Am Econ J Appl Econ. 2009;5(4):61-91. doi:10.1257/app.5.4.61.
Gröne O, Garcia-Barbero M. Integrated care: a position paper of the WHO European Office for Integrated Health Care Services. Int J Integr Care. 2001;1:e21.
Swanson RC, Atun R, Best A, et al. Strengthening health systems in low-income countries by enhancing organizational capacities and improving institutions. Global Health. 2015;11:5. doi:10.1186/s12992-015-0090-3
McPake B, Kutzin J. Methods for Evaluating Effects on Health Reforms. Geneva: WHO; 1997.
Christoph K, Ortiz L. Mexico’s Social Protection System in Health and the Financial Protection of Citizens Without Social Security. Washington, DC: World Bank; 2012.
De Andrade LO, Pellegrini Filho A, Solar O, et al. Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries. Lancet. 2015;385(9975):1343-1351. doi:10.1016/s0140-6736(14)61494-x